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Stuck in the coverage gap, with dreams of being a nurse

Katie Dorr, 29-year-old a second-year nursing student, pays $125 a month for the least expensive health insurance she could find. Enrollment is required for her to continue her studies.
Durrie Bouscaren | St. Louis Public Radio
Katie Dorr, 29-year-old a second-year nursing student, pays $125 a month for the least expensive health insurance she could find. Health insurance is required for her to continue her studies.

In this season of open enrollment for health insurance under the Affordable Care Act, there’s a group of people who might be uninsured: nursing students.

Nursing schools frequently require, or highly recommend, that students be enrolled in a health insurance plan before participating in clinical work at local hospitals. Because the Missouri legislature has turned down Medicaid expansion three years in a row, students who work part-time or don’t have insurance through their parents may fall into a coverage gap: Their incomes are too high for Missouri’s Medicaid program, and too low for income-based subsidies to help them buy insurance on Healthcare.gov.

“I’m kind of just in no-man’s land,” said 29-year-old Katie Dorr, a second-year nursing student at St. Louis Community College.

After two years without Medicaid expansion in Missouri, an estimated 90,000 residents of the St. Louis region are still uninsured. Like Dorr, many of them have incomes that fit into the coverage gap. 

After five years working as a medical technologist in a hospital, Dorr decided to follow iin her mother’s footsteps and go to nursing school. Because she had to cut back her work hours to allow for classwork, she no longer qualified for her employer’s benefit plan. Dorr's new income places her below the cutoff to qualify for subsidies. Also, she doesn’t have children, so she is ineligible for Medicaid.

Without health insurance, Dorr can’t finish her nursing program, so she pays $125 a month for a private plan. She had found an option on Healthcare.gov, but it was even more expensive.

“It’s just frustrating,” Dorr said. “I have to come up with so much money a month to pay my rent and pay my insurance and still study.”

The health insurance requirement has always been in SLCC’s contracts with local hospitals where the students do clinical work, said nursing education director Karen Mayes. But after an anonymous poll, she found that about a quarter of the students did not have health insurance. Now, they’re required to show proof.

“If accidents were to happen, they need to be able to cover their expenses,” Mayes said.

In addition to health insurance, nursing students are required to have a full list of immunizations. Liability insurance for medical malpractice is provided by the school.

On Monday, Dorr and a half dozen of her classmates met with certified application counselors from Cover Missouri, an arm of the Missouri Foundation for Health that assists with health insurance sign-ups.

Hub manager Laura Burbank, of Planned Parenthood of the St. Louis Region and Southwest Missouri, said almost all of the students they met with fit into the coverage gap.

“You have people coming in who are trying to do the right thing, they want to get enrolled, because they understand how important it is to their health and education. It’s not like they’re not looking or trying to take advantage of the system or anything.” Burbank said. “It’s heartbreaking.”

Follow Durrie on Twitter: @durrieB

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